Healthcare Provider Details

I. General information

NPI: 1134695133
Provider Name (Legal Business Name): HISPANO AMERICAN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E IRLO BRONSON MEMORIAL HWY OFC 1714A
SAINT CLOUD FL
34771-5806
US

IV. Provider business mailing address

1714 E IRLO BRONSON MEMORIAL HWY STE A
SAINT CLOUD FL
34771-5836
US

V. Phone/Fax

Practice location:
  • Phone: 407-583-4795
  • Fax: 407-583-6412
Mailing address:
  • Phone: 407-583-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MADELINE VEGA
Title or Position: OWNER
Credential:
Phone: 407-404-0077